Fluids & Electrolytes
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| How much wt of adult is fluid? child? | 60%, younger, thin, and men have more fluid. lean mass = decr fluid
child: 80%
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| what are the two fluid compartments | ICF: intracellular 2/3 body, 40%
ECF: extracellular, 1/3 body, 20%
Ex: 70kg has 42L h2o...30L in cells, 11L in man
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| how many liters of blood does body contain | 6L...3L = plasma, 3L = rbc,wbc, thrombocytes
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| what is third spacing | loss of ECF into space it does not belong. Edema. Occer w/ hypocalcemia, decr iron intake, liver disease, alcoholism, hypothyroidism, malabsorption, immobility, burns, cancer
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| what are major cations in body fluid | ICF: K,Mg,Na
ECF: NA, K, Ca, Mg
potassium, sodium, mag, calcium, hydrogen
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| what are major anions in body fluid | ICF: PO4,S,hCO3,proteinate
ECF: Cl-,HCO3,PO,S
Chloride, Bicarbonate, Phosphate, Sulfate, proteinate
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| What are three compartments of ECF | Intravascular - inside vessels
interstitial/ECF: between cells, lymph
transcellular: cerebrospinal, pericardial, synovial,intraocular,pleural,sweat,digestive
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| how much fluid is secreted in and reabsorbed from GI | 3-6L
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| 1L = how many lbs Acute loss of 0.5kg(1lb) = fluid loss of? | 1L = 2 lbs
500ml
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| What are fx of body fluid | 1. transport 02,food,waste
2.regulate temp
3.lubricate joints/tissues
4.medium for food digestion
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| What are three fluid spacings | 1st - ICF, ECF
2nd - edema: fluid in interstitial
3rd - lg shift w/ inflammation, ascites, interstitial edema
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| ss of fluid shift from vascular to interstitial | weak, rapid pulse, cold extremeties, hypotension, oliguria
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| tx for fluid shift from vascular to interstitial | treat cause: inflammatory, autoimmune, loss of proteins, burns
manage hypovolemia w/ colloids, diuretics/fluid restriction
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| Nursing tx for fluid shift from vascular to interstitial | I/O, abd girth, neuro chks, balanced diet, wt
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| S/S fluid shift interstitial > vascular | bounding pulse, crackles, incr BP, jugular vein distention
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| tx for fluid shift from interstitial > vascular | treat case, manage hypervolemia w/ diurectics/fluid restriction, vasodilators
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| nursing tx for fluid shift from interstitial > vascular | I/O, daily wts, neuro chk, balanced diet
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| Mvmt of fluid thru capillary walls depends on | hydrostatic pressure and osmotic pressure
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| what is hydrostatic pressure | pressure exerted on walls of blood vessels pushing(forced) fluid through to ECF.
Solute move from higher concentration > lower
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| what is osmotic pressure, oncotic, colloidal osmotic | pull water back into capillaries exerted by protein(albumin) in plasma.
Low solute concentration > high
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| What is filtration | mvmt of water, solutes from high hydrostatic pressure to low wtih semi-permeable membrane as a result of hydrostatic pressure
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| what is active transport | NA-K pump moves fluid and solutes from lower concentration > higher against concentration gradient, need ATP
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| What are two types of diffusion | simple, facilitated
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| what is simple diffusion | mvmt of molecules from high > low, and must have permeable membrane, no energy
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| what is facilitated diffusion | use specific carrier molecules to accelerate diffusion
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| what is osmolality/ osmolarity | osmolality: amt of solutes in 1 L of fluid, incr osmo move to decr
osmolarity: controlled by hypothal, regulates amt of fluid in each of 3 compartments
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| what is isotonic env | solute and free water concentration are same inside/outside cell. water flow equal rate
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| what is hypertonic env | solute conc is greater outside cell, free water greater inside, so free water flows out of cell, so shrinks
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| what is hypotonic env | solute greater inside cell, free water greater outside, so water flows into cell, bursting
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| What is kept in balance with NA-K pump | Na diffuses into cell, so pumped out of cell into ECF, K pumped into cell(ICF) w/ ATP
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| what are Average Daily I/O | Intake Total:2100-2900 fluids(IV/PO)/1500-2000, Solids/900-1000, Oxidation/2-400...
Out Tot: 21-2900
kidneys/15-2000, skin/6-700, GI/1-200, Lungs/4-500
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| hypovolemia triggers body to | incr thirt, incr ADH(incr h2o by kidney), decr urine. renin release(vasoconstrict), incr aldosterone, decr urine
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| hypervolemia triggers body to | incr ANP/BNP(decr RA system, aldosterone, ADH), incr GFR, incr urine
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| How does kidney's regulate F & E | 1.selective retention/excretion fluids
2.reg electrolyte levels by ret/exr
3.reg pH by ret of H ions
4.exr waste/toxic sub
(filter 170L/day plasma, exr 1500mls(1.2L)/day, respond to aldosterone/ADH
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| What does Kidney use to regulate F&E? Heart? Hypothalamus/post pituitary? Adrenal Cortex? | Kidney: renin
Heart: ANP/BNP
Hypo: ADH
Adrenal: Aldosterone
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| what are baroreceptors | in left atrium(catotids), stimulate SNS: incr HR, contractility, circulating blood volume, constricts renal arterioles, incr aldo(hold h2o/na)
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| what are osmoreceptors | on hypo and sense change in Na as incr..ADH released to kidney to hold h2o
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| How does ANP work | incr blood volume, BP stretch atria and shuts off RA/ADH systems
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| how is renin angiotensin system released | activated by decr blood to kidney, so renin by kidney, converts angiotensin in liver to I(mild vasoconstricotr), then in lung to II, which stimulate cortex to release aldo...incr BP, maintain blood volume
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| Aldosterone does what | secreted by outer zone of adrenal cortex and incr Na/H2o retention, with K loss
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| What does cortisol do adn where | in adrenal cortex, retains Na/fluid
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| What do parathyroid hormones do for homeostasis | in thyroid gland, regulate Ca and PO balance by bone resorbtion, Ca absorption in intestines and renal tubules
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| how does pituitary gland help homeostasis | hypothalamus reg ADH stored in post pituitary, which conserves H2O, maintain osmotic pressure of cells
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| How does Cushing's syndrome affect F&E? SIADH? DI? | Cushing's: incr corticosteroids
SIADH: incr ADH r/t brain/lung tumors(hold H2O)
DI: decr ADH (can't hold h2o)
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| what are s/s of Diabetes insipedis | polyuria, thirst, fatigue, dehydration
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| What diagnotics are for DI? | urine specific gravity (<1.010), Na>145, incr BUN, serum osmolality
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| what are tx of DI? | monitor urine output, fix fluid deficit w/ hypotonic(1/2NS), replace ADH
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| what r s/s of SIADH | decr serum Na/osmal, oliguria(incr urine), vol overload, N/V/D, dyspnea, pulm edema, HA, altered LOC, seizures, muscle weakness/cramps
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| Tx for SIADH | DC causative drugs, fluid restriction, 3%NaCl, seizure precautions
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| how to find MAP | 22 x DBP + SBP/3
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| FVD- fluid volume deficit S/S | restless, oliguria/conc. urine, postural hypo, rapid pulse, decr temp, cool, clammy skin, muscle weak, cramp
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| nursing tx for FVD | I/O, skin/tongue turgor, daily wts, VS, urine specific gravity
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| severe FVD S/S | tears absent, membranes dry, sunken eyes, tachy, slow cap refill, cool extremities, apathy somnolence
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| Serum electrolyte changes can be found where in the body | hypokalemia(GI/renal losses)
hyperkalemia(adrenal insuff)
hyponatremia(incr thirst/ADH release)
hypernatremia(insensible losses/DI)
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| S/S of FVE | edema, bound PP, distend neck vv, crackles, tachy, S3, incr BP/PP/CVP/Wt/UO, SOB/wheeze, seizure w/ cranial press
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| tx for FVE | restrict fluids/na, diruetics, dig, nitro, morphine, hemodialysis
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| Nsg tx for FVE | I/O, daily wts, assess lung(acid/base bal), edema, restrict fluids/Na, semi fowlers, turn/cough/deep/breath
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| what are electrolytes | chemical that carry cations+ and anion- electrical charges that move to lower conc and to opp charges
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| what is insensible loss snesible loss? | continuous evap thru skin(600ml/day), lungs(300ml/day)
sensible: sweating(0-1000), GI(1-200ml/day)
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| what is urine specific gravity | measures kidneys' ability to excrete/conserve water. Compared to wt of distilled water...1.010-1.025, lgr vol of urine = lower sp. gravity
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| what is BUN | made up or urea, by product of protein metabolism
10-20mg/dL
incr: dehydration, incr prtotein, GI bleed, decr renal fx
Decr: liver dis, low protein diet, starvation, preg
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| what is creatinine | end product of muscle metabolism, better renal indicator
0.7-1.4mg/dL
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| what is hematocrit, Hct? | vol. of RBCs
males: 42%-52%
female: 35%-47%
incr: dehydration, polycythemia
decr: overhydration, anemia
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| what organs are involved with homeostasis | kidneys, lungs, heart, adrenal glands, parathyroid glands, pituitary gland
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| What leads to incr interstitial fluid | Na retention, burns, infections, albumin <1.5, decr osmotic pressure
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| Sodium normal values | 135-145mEq/L
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| what causes hyponatremia | Na <135, imbalance of water rather than sodium b/c water follows sodium. As Na level decr, H2O pulled into cells
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| S/S hyponatremia | HA, decr saliva, orthostatic fall in BP, N/V, abd cramps, alterer mental, coma, status epilepticus
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| Tx for hyponatremia | Na by PO/nasogastric/parenteral, restrict H2O 800ml/24hrs, (if edema alone: Na restricted), (if edema and hyponatremia: H20/Na restrict)
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| what auses hypernatremia | Na >145, caused by hypertonic enteral feedings, excess Na HCO3, hyperventilation, burns, DI, heat stroke, D, fever, incr BS
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| S/S of hypernatremia | neurologic, restless, weakness, dehydration
3 types: hypovolemic, Euvolemic, hypervolemic
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| tx of hypernatremia | hypotonic solution(0.3% NaCl), isotonic(D5W, replace h2o w/o na)
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| Potassium | normal 3.5-5.0 mEq/L, regulated by kidneys by adjusting amt of K excr in urine. Aldosterone incr excr of K
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| what causes hypokalemia | <3.5- reduce excitability of cell, so less responsive, alkalosis- temporary shift of K into cells, GI loss(V/D, GI suction), hyperaldosteronism, insulin hypersecretion, bulemia, mg loss, meds
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| S/S of hypokalemia | death, fatigue, anorexia, N/V/D, muscle weakness, leg cramps, decr bowel motility, paresthesias, weak pulse, shallow resp, thirst, dysrhythmias. (hemolysis: false low)
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| EKG changes with hypokalemia | flat T waves, elevate U wave
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| tx for hypokalemia | incr dietary K(bananas,apricots,oranges,whole grain, milk,meat) /replacement (Aldactone), IV for severe deficit, monitor ECG/ABGs
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| what causes hyperkalemia | >5.0mEq/L, cell more excitable, acidosis, retention of K, excess release of K(burns), excess IV/PO of K. Renal probs more at risk
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| S/S of hyperkalemia | dysrythmias, muscle weak, paresthesias, anxiety, tachy then brady, hypotension, N/D(explosive)
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| EKG changes in hyperkalemia | tall T waves
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| tx for hyperkalemia | IV Ca gluconate, incr fluids, Na bicarb IV, K wasting diuretics, Kaexylate, low K diet, dialysis
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| Calcium | 8.6-10.2mEq/L, most abundant ion, works with phosphorus for bones/teeth,
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| what causes hypocalcemia | <8.6, Cushing's dis, metabolic alkalosis, meds, poor absorption in gut, vit D difficiency
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| S/S of hypocalcemia | tetany, trousseaus sign(BP cuff), Chvostek's sign(tap cheek), dyspnea, D, prolong QT, hypotension, seizure,
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| tx for hypocalcemia | Ca replacement, O2, High Ca, low phosphorus diet (gr leafy, milk, salmon, sardines), Vit. D, antacids, wt bearing,
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| Nsg tx for hypocalcemia | Adm Ca, monitor cardiac rhythms, assess dig toxicity, trousseau's/Chvostek's sign, monitor incr bleeding, safety
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| what causes hypercalcemia | >10.5, malignancy, hyperparathyroidism, immobility, metabolic acidosis
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| S/S of hypercalcemia | anorexia, N/V, constipation, muscle weakness, abd/bone pain, polyuria, thirst, dysrhythmias, kidney stones
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| tx of hypercalcemia | fluids, lasix, IV NS, phophates, calcitonin, biphosphonates
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| nsg tx of hypercalcemia | encourage ambulation, fluids(3-4L/day) w/ Na, fiber
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| Magnesium | 1.3-2.3 mg/dL
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| What does Mg do? | important in neuromuscular fx, most abundant cation, bones have 60%, linked to albumin levels, influences Ca level thru PTH,
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| what are dietary sources of MG | chocolate, dry beans/peas, nuts,
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| what causes hypomagnesium | <1.5, alcoholism, DM, renal disease
Also look for hypocalcemia
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| S/S of hypomagnesium | Chevoskek's sign, Trousseau's sign
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| Memory Jogger for hypomag | STARVED
S-seizures
T-tetany
A-Anorexia/arrhythmias
R-Rapid HR
V-Vomiting
E-emotional lability
D-Deep tendon reflexes incr
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| Tx for hypomag | adm mg sulfate slowly, no faster than 150mg/min
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| What is hypermagnesium | >2.5, decr CNS: drowsy/lethargic,coma
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| S/S of hypermag | RENAL(common cause renal failure)
R-Reflexes decr
E-Electrocardiogram changes,
brady, hypotension
N-N/V
A-Appearance flushed
L-Lethargy
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| Tx of hypermag | IV or Ca gluconate in emergency
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| Phosphorus | 2.5-4.5 mg/dL
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| What does Phosphorus do | essential fx of cell membrane integrity, muscle/RBCs, formation of ATP, structure to bones/teeth.
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| Sources of dietary phosphorus | Mainly from diet: dried beans, eggs, fish, dairy, organ meats(brain/liver)
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| Hypophosphetemia hyper | <2.5, respiratory alkalosis causes, sugar high
>4.5, chemotherapy causes
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| S/S of hypophosphetemia/hyper | muscle weakness
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| Plasma pH | 7.35-7.45
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| 3 mechanisms to maintain pH | chemical buffers: bicarbonate, phosphate, protein
Lungs: regulate CO2
Kidneys: absorb/excrete acids or produce bicarbonate
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| Acids vs bases | Acids: give up or donate H+, lower pH
Bases: accept H+, higher pH
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| If incr acid | decr pH, kidney absorb HCO3 and excrete H+/P/ammonia
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| If decr acid | incr pH, kidney excrete HCO3
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| compensation means | pH returns to normal
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| PaCO2 and pH move | opposite, if paCO2 rises, pH falls
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| what is normal paCO2 normal paO2 normal SaO2 | CO2: 35-45
O2: 80-100
SaO2: 95-100%
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| pH and HCO3(bicarbonate) | incr/decr together
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| Quick look at ABGs | 1.check pH
2.check paCO2
3.Check bicarbonate
4.Check for signs of compensation
5.Check PaO2/SaO2
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| How to figure anion gap | gap bn two measurements, <14 is incr in one or more unmeasured anions in blood. Normal 8-12mEq/L
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| metabolic acidosis | low pH, incr H+, low HCO3, low CO2,
Compensation: hyperventilation lowering CO2(conserves HCO3)
hyperkalemia, direct loss of bicarbonate in diarrhea
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| S/S metabolic acidosis | HA, confusion, drowsy, incr resp/depth, N/V, vasodilation, decr CO, decr bp, clammy skin
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| Metabolic alkalosis | high pH, high HCO3, high CO2,
Compensation: hypoventilation with incr CO2
Vomiting, gastric suction, hypokalemia, hypocalcemia
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| S/S metabolic alkalosis | tingling, dizzy
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| respiratory acidosis | low pH/<7.35, high CO2 >45, high/normal HCO3
Compensation: incr HCO3
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| respiratory alkalosis | high pH/>7.45, low CO2 <35, low/normal HCO3, hyperventilation
Compensation: decr HCO3
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| Isotonic fluids | total osmolality close to ECF, expander (3L to replace 1L blood loss)
Ex: NS 0.9%, D5W, LR
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| What is NS 0.9% used for and not used for | Na losses, burns NOT heart failure, Pulmonary edema, renal impairment, Na retention
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| Why is D5W not always isotonic | Glucose burned up and become hypotonic entering cells. Not good kcal replacement
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| what does LR contain | K, Ca, NA/Cl, used to correct dehydration, Na depletion, replace GI loss
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| hypotonic fluids | replace cellular fluid, give free water for excretion of body wastes. Can lead to decr intravascular, decr BP, cell edema/damage
ex: .45%NS
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| hypertonic fluids | 5% dextrose, draw water from ICF to ECF. Again dextrose burns up and left with isotonic
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| which needle gauge is best for IV fluids? blood: | IV:20-22
blood: 14-18
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| How often should IV be replaced | q 3days
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| Infiltration is evidenced by | edema @ insertion site, leakage, coolness, decr flow rate
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| Phlebitis is evidenced by | inflammation of vein, reddened, warm, pain, tenderness, swelling
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| Thrombophlebitis is evidenced by | local pain, red, warm, swelling
TX: cold compress first followed by warm compress, elevate, restart in other arm
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